Sick leave rates are decreasing in Sweden overall, but these rates follow the international trend of higher sick leave for women than men. This study focuses on the associations between social capital measures and return to work (RTW) among women on long-term sick leave. Questionnaire data were collected at four times from a cohort of long-term sick women (n=324). The preliminary results suggest women that reported having someone they feel very close to, having someone they can share happiness with and being comforted by being held in someone’s arms increased in work ability score and working degree significantly more over time compared to women who had no such friend/relationship. Additionally, women with shared household duties and women allowed to take a short break at work but not at home, increased in work ability score and working degree significantly more over time compared to women with major responsibility for the household, no opportunity for breaks at work and an accepting climate for break taking at home. These results highlight the importance of social attachment, a basis of equality and a good work environment that allows moments of rest in order to increase work ability and improve the RTW process.

3. Life without professional work-perceptionsabout one’s self, interpersonal relations andsocial life after retirement

Dalheim Englund, Ann-Charlotte

et al.

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

Carlsson, Gunilla

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

Nyström, Maria

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

Gillsjö, Catharina

University of Skövde.

Eriksson, Irene

University of Skövde.

Palmér, Lina

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

The aim of this study is to understand how healthy, older adults in Sweden perceive their life situation after retirement. The study is based on a lifeworld approach, and a phenomenographic method was used. Eighteen participants were interviewed, and data were analysed according to the phenomenographic principle of qualitatively different categories. Two categories were developed. The first category, “perceptions that draw attention inward, towards one’s self”, was further described in three subcategories: Sense of decreased status in society, the desire to keep aging at a distance, and contemplation of one’s own existence. The second category, “perceptions that draw attention outward, away from one’s self” was further described in the following four subcategories: caretaking of family members, involvement in social relationships, finding of deep meaning in animals and nature and engagement with society. In the discussion, the findings are further illuminated through comparisons with concepts such as maturity, wisdom and gerotranscendence, and reflections on the findings ‘relevance to a caring context follow. The conclusion suggests this study can provide knowledge that will allow healthcare providers to bridge the gap between generations in order to provide high-quality care. However, for a more profound caring dialogue, for example, about the end of life, a deeper analysis is required.

In multicultural societies, health care professionals encounter immigrant families of children with asthma. They play an important role in supporting these families, but few studies have focused on this phenomenon. The aim of the present study is to gain a broader understanding of the challenges health care professionals face in their encounters with non-Western immigrant parents of children with asthma. Seventeen professional caregivers were interviewed, and their narratives were analyzed using qualitative content analysis. The results show that health care professionals’ main challenges when encountering immigrant parents can be described by the theme, “Turning oneself inside out.” This theme is characterized by five categories: gender and professional issues, impact on professional relationships, communication challenges, unfamiliar disease and treatment perceptions, and time issues. The results highlight the importance of providing health care professionals with support and organizational conditions that increase opportunities to understand the unique situation of these families

AbstractAim To investigate the relationships between return to work and social support outside work among women on long-term sick leave from human service organizations. Background Work is an important part of life and is, in general, considered to be supportive of health and wellbeing. Few studies have thoroughly investigated the importance of aspects of social support outside work for return to work. Methods A cohort of women on long-term sick leave was followed with questionnaires from 2005 to 2012. Results The availability of social attachment increased the women's work ability, return to work, and vitality significantly more over time. There were positive relationships between return to work and seeking support in terms of emotional support and comfort and expressing unpleasant feelings. Conclusions Important resources to increase return to work can be found in factors outside work, such as close social relationships and support seeking. Thus, it is important to take the woman's whole life situation into account and not focus solely on aspects related to the workplace.

BACKGROUND: Asthma is the most common chronic childhood disease. Childhood asthma contributes significantly to morbidity among children and has a significant impact on the quality of life (QoL) and daily routines of both the children and their parents. AIM AND OBJECTIVE: The purpose of this study was to investigate how Swedish parents of children with asthma experience their QoL, and to investigate whether there were differences concerning QoL between parents within the same family. The purpose was also to investigate possible connections between their QoL and background variables. METHOD: A total of 371 parents of children with asthma (57% mothers and 43% fathers) participated in the study. The Paediatric Asthma Caregiver's Quality Of Life Questionnaire (PACQLQ) was used to measure the parents' QoL, i.e. how the child's asthma interferes with the parents' normal activities and how it has made them feel. RESULTS: The findings show that most parents of children with asthma evaluated their QoL as close to the positive end of the scale, and there was close agreement in the scoring between parents within the same family. Significant associations were found between parents' lower QoL outcome and living in the North of Sweden. There were also significant associations between fathers' lower QoL outcome and having a child younger than 13 years of age and mothers' lower QoL outcome and having a child with severe asthma. Although the result shows that a child's asthma did not influence the parents' QoL to a greater degree, it is still important for healthcare workers to help these parents to sustain and improve their well-being. CONCLUSIONS: The fact that they just evaluated their QoL during the preceding week only, and did so at the time when their children were being treated with asthma medication, might have influenced the results in a positive direction. Comment in Commentary on Dalheim-Englund et al. (2004) Having a child with asthma: quality of life for Swedish parents. Journal of Clinical Nursing 13, 386-395. [J Clin Nurs. 2005]

All communities set high expectations on parents and to raise a child is a challenging responsibility. Being a parent includes feelings of pleasure, but is also associated with concem and extra work. If the child is stricken by a chronic illness their concem and extra work more often than not will increase. One of the most common chronic diseases among children world-wide is asthma and it constitutes a considerable health problem. Current literature shows that asthma brings uncertainty and extra work to family life, which influences many aspects of a farnily's health and social life. In a Swedish study, it is found that mothers and fathers of children with asthma manage their uncertainty in different ways - mothers mostly act in a protecting manner and express feelings of sadness, while fathers act in a liberating manner and express feelings of acceptance. Furthermore, another Swedish study points out the fact that the relations among asthma family members are govemed by uncertainty and characterized by control, tight bonds and feelings of being forsaken and lack of understanding. From the literature and studies mentioned above, one can assume that living under such circumstances may not only affect family members' present life, but it may also affect their future. Uncertainty puts a great drain on the family, e.g. misunderstanding between parents can occur, siblings may feel forsaken and the child with asthma may be prevented from taking an own responsibility for life with the disease. One way to get a deeper understanding of human relations is to use different perspectives. In this article, we will try to illurninate asthma family life and relations by using an existentialistic, a Hegelian as well as a gender perspective.

In English To meet and work with teenagers may be a challenge for caregivers as adolescence is a period when youths try to establish autonomy. Although asthma is an increasing problem worldwide, few studies have addressed professional caregivers' motives and actions. Therefore, the aim of this study was to describe professional caregivers' strategies in their work with teenagers with asthma. Grounded theory, inspired by Glaser, was used to uncover the phenomenon. The informants were seven professional caregivers who worked at an eight-day asthma camp for teenagers in Sweden. Participant observations and interviews were used, and the first author collected the data and participated in the activities. Findings show that professional caregivers' core concern is to assist teenagers with asthma to take command. This core concern gives rise to five strategies: showing respect, being at hand, promoting own responsibility, promoting to exceed boundaries and promoting reflections. In professional caregivers' attempt to assist teenagers to take command some differences are seen in the way they support boys and girls. One conclusion drawn from our study is that the provisional theory of 'Assisting teenagers with asthma to take command' is not only suitable for professional caregivers working at asthma camps; it may, in some degree, also be used as a source of inspiration for professional caregivers in other settings.

The aim of this study is to describe what it means to be parents of a child with asthma. Unstructured interviews were carried out with 12 mothers and 12 fathers of children with asthma living in Sweden. The parents' accounts were analyzed using a phenomenological-hermeneutic approach. The results revealed that parents were living a strenuous life and their actions involved both protecting and liberating. Parents also reported feelings of sadness and acceptance. In most cases, mothers acted in a protecting manner and expressed feelings of sadness; fathers acted in a liberating manner and expressed feelings of acceptance. To gain a deeper understanding of the parents' actions and feelings, study results were interpreted through philosophical perspectives described by Ruddick (1989), Mayeroff (1965), and Hegel (1975). These interpretations show that the feelings and actions of these parents exist in a dialectical relation with one another. Results emphasize the importance of a good partnership between the parents and the nurse, where the nurse shows consideration for the parents' unique actions and feelings and understands and supports parents in the care of their child with asthma.

11. A responsibility that never rests - To be a family caregiver to an older person

Jarling, Aleksandra

et al.

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

Rydström, Ingela

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

Ernsth-Bravell, Marie

Institute of Gerontology, Jönköping University.

Nyström, Maria

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

Dalheim Englund, Ann-Charlotte

University of Borås, Faculty of Caring Science, Work Life and Social Welfare.

When the ageing population increases, the burden and responsibility of close family members will likely increase. Those closely related who assume a great responsibility can be significantly affected in health, well‐being and daily life.

Aim

This study aims to describe the life situation when family caregivers are imposed responsibility for an older person with complex care needs in their own home.

Methods

In this Swedish qualitative study, ten family caregivers were strategically selected in order to achieve variations in the life situation. A reflective lifeworld research design based on phenomenological philosophy was used throughout the data collection with the lifeworld interviews and the analytic process.

Findings

In terms of extensive responsibility, the life situation is complex and involves emotions that are difficult to manage. In essence, a paradoxical life situation is described which is experienced as both voluntarily and nonchosen at the same time. The responsibility never rests. The essential meaning is further illustrated with three constituents: loss of freedom, contradictory feelings and affected relationships.

Conclusion

A life situation with extensive responsibility for an older family member interferes with the whole life situation with an impact on health and relationships with other people. The findings are crucial for professional caregivers in order to capture the nature of family support in a way that enables a meaningful life for both the family caregiver and the older person being cared for. Knowledge of this will give professional caregivers an increased awareness of the life situation of family caregivers and provide a better understanding of the support they are longing for, and, in some countries, such as Sweden, also are entitled to by law.

AbstractBackground: In line with changing demographics, conditions for older people have also changed. Older people are expected to live and be cared for in their own home for as long as possible. Increasing age also increases the risk of multimorbidity and the need for social services and health care services. Home care, instituted by different laws, is complex and requires cooperation from an older person when his/her home becomes a workplace for service providers.

Aim: This study aims to illuminate the meaning of being an older person with multimorbidity who lives alone and who is cared for in his/her own home.

Design: This study uses a qualitative design with a lifeworld approach.

Methods: Conducted in Sweden in 2016, the researchers interviewed 12 older persons that live alone and receive home care. Data was analysed using qualitative content analysis.

Results: The findings illustrate four sub-themes: adapting to a caring culture, being exposed, participation with limitations and being dependent on forced relationships. The overall theme reveals that older people experience a life-changing situation when receiving home care and they become a guest in their own home.

Conclusions: Becoming older with increased needs means to disrupt one’s life when one’s private home becomes a public arena. Caregivers need to be aware of the gap between their rights by law and an older person’s experiences of receiving home care. Only then can care be offered that enables older people to have a sense of control and experience their home as their own.

Implications for Practice: The findings emphasise the need to view older people as being self-determinant and independent. Older people receiving home care need to be seen as individuals, and their entire life situation should be considered by also acknowledging the important role played by relatives and caregivers.

To meet the Swedish healthcare legislation’s requirements for evidence-based care, a work model for reflection has been developed, called a reflective team (RT). Because this RT model can be perceived as either a competitor of or a complement to caring supervision, this case study aims to explore what distinguishes these two in psychiatric care. Five members of one RT who are psychiatric nurses with previous experiences in caring supervision were interviewed. The transcribed interviews were analysed according to phenomenography. The findings reveal three qualitatively separated categories, which describe differences in focus, competencies, and relationships between confirmation and demands. It is concluded that an RT by no means replaces supervision. Instead, both can contribute to care improvement by complementing each other and increasing the professionalism of psychiatric nurses

Needle-related medical procedures (NRMPs) are something that all young children need to undergo at some point. These procedures may involve feelings of fear, pain and anxiety, which can cause problems later in life either when seeking healthcare in general or when seeking care specifically involving needles. More knowledge is needed about supporting children during these procedures.

AIM:

This study aims to explain and understand the meaning of the research phenomenon: support during NRMPs. The lived experiences of the phenomenon are interpreted from the perspective of younger children.

METHOD:

The analysis uses a lifeworld hermeneutic approach based on participant observations and interviews with children between 3 and 7years of age who have experienced NRMPs.

RESULTS:

The research phenomenon, support for younger children during NRMPs, is understood through the following themes: being the centre of attention, getting help with distractions, being pampered, becoming involved, entrusting oneself to the safety of adults and being rewarded. A comprehensive understanding is presented wherein younger children experience support from adults during NRMPs in order to establish resources and/or strengthen existing resources.

CONCLUSIONS:

The manner in which the child will be guided through the procedure is developed based on the child's reactions. This approach demonstrates that children are actively participating during NRMPs. Supporting younger children during NRMPs consists of guiding them through a shared situation that is mutually beneficial to the child, the parent and the nurse. Play during NRMP is an important tool that enables the support to be perceived as positive.

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child’s horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child’s advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents’ ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as ‘‘balancing on a tightrope’’ in an unpredictable situation.

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents' ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as "balancing on a tightrope" in an unpredictable situation.

Background Needle-related medical procedures (NRMPs) are often frightening and cause children anxiety and pain. Only a few studies have examined the perspectives of younger children. More knowledge is needed about younger children's experiences in caring situations such as NRMPs. Aim The aim of this study was to explain and understand the consequences related to NRMPs from younger children's perspectives. Methods Participant observations and interviews with younger children who had experienced NRMPs were analysed using a lifeworld hermeneutic approach. Results Experiencing fear is central for younger children during an NRMP and interpretation of its consequences formed the basis for the following themes: seeking security, realizing the adult's power, struggling for control, feeling ashamed, and surrendering. A comprehensive understanding is presented wherein younger children's experiences of NRMPs vary across time and space related to weakening and strengthening their feelings of fear. Conclusions Awareness is needed that adults' power becomes more obvious for children during an NRMP. Children's surrender does not necessarily imply acceptance of the procedure. Providing children with opportunities to control elements of the procedure creates a foundation for active participation, and vice versa.

This study investigates existential matters in the third age of life, which encompasses the years after retirement and ends when extensive support needs emerge in the fourth age. As the theoretical starting point in a lifeworld hermeneutic approach, 18 healthy older adults were interviewed about what it means for them to grow old. The interviews were interpreted according to Gadamer’s principles of openness and Ricoeur’s proposal to provide suggestions on how meaning can be explained. The findings are presented in three interpreted themes: Feeling free, Becoming vulnerable, and Existing in closeness to death. The themes are further interpreted, and a comprehensive understanding is reached with theoretical support from Jean-Paul Sartre’s idea of factuality and project. The meaning of growing old is discussed in terms of positive factors, such as healthy aging, transition and gerotranscendence, but also in respect to concerns over future suffering in relation to illness and dependence. It is concluded that the freedom of the third age is greatly appreciated for a healthy life, but also threatened by increased risks of ill health. It is not morbidity in itself that worries most, but the risk of being dependent on care and support from others. This is important to consider when planning and performing care in order to promote a healthy aging.

Coming to a new country involves many challenges. One of them is to approach a new health care system when you have a child with asthma. The aim of this study was to gain a broader understanding of immigrant parents’ experiences of the Swedish health care system. Twelve parents of children with asthma were interviewed and their narratives were analyzed by using qualitative content analysis. The results show that immigrant parents’ experiences of Swedish health care vary and involve both advantages and disadvantages. Advantages of the Swedish health care system are described as Being met with respect and Affordable care, while disadvantages are described as Problems with communication, Being discriminated against and Lack of confidence. The disadvantages are challenges for health care professionals, who are expected to offer care on equal terms to the whole population. Therefore, they need to provide culturally competent care and encourage immigrant parents to voice their expectations and worries.

The workplace is an essential source of social capital for many people; it provides mutual support and gives meaning to life. However, few prospective studies have thoroughly investigated the importance of aspects of social capital in the workplace. The aim of this study was to investigate the associations between aspects of social capital (social support, sense of community, and quality of leadership) at the workplace, and work ability, working degree, and vitality among women with a history of long-term sick leave from human service organizations.

Methods

A longitudinal cohort study was performed among women with a history of long-term sick leave. The study started in 2005, and the women were followed up at 6 months, 1 year, and 6 years using self-reported questionnaires (baseline n = 283). Linear mixed models were used for longitudinal analysis of the repeated measurements of prospective degree of work ability, working degree, and vitality. Analyses were performed with different models; the explanatory variables for each model were social support, sense of community, and quality of leadership and time.

Results

Social capital in terms of quality of leadership (being good at solving conflicts and giving high priority to job satisfaction), sense of community (co-operation between colleagues) and social support (help and support from immediate superiors and colleagues) increased the women’s work ability score (WAS) as well as working degree over time. Additionally, social capital in terms of quality of leadership increased the women’s vitality score over time.

Conclusions

A sustainable return-to-work process among individuals with a history of long-term sick leave, going in and out of work participation, could be supported with social support, good quality of leadership, and a sense of community at the workplace. The responsibility for the rehabilitation process can not be reduced to an individual problem, but ought to include all stakeholders involved in the process, such as managers, colleagues, health care services, and the social security agency.

Aims and objectives. The purpose of this study was to describe how Swedish children with asthma experience their QoL and to search for possible associations between their experience of QoL and some determinants. Background. Asthma is a chronic disorder that can restrict a child's life, physically, emotionally, socially and spiritually, and this has an impact on a child's quality of life (QoL). Methods. Two hundred and twenty-six children with asthma (37% girls and 63% boys) and 371 parents of these children participated in the study. The Paediatric Asthma Quality Of Life Questionnaire (PAQLQ) was used to measure the children's QoL. This questionnaire reveals how the children's asthma interferes with their normal activities, their symptoms and how this interference has made them feel. Results. The findings show that most children with asthma estimated their QoL towards the positive end of the scale. The children reported more impairment in the domain of activities than in emotions and symptoms. The most commonly restricted activity was the children's ability to run. Significant associations were found between a higher QoL outcome and being a boy, as well as living in the south of Sweden. A higher QoL was also found in children with mothers older than 40 years of age and in children with cohabiting parents. It was also associated with their fathers’ QoL in a positive direction. Conclusions. It is important that children with asthma will maintain a high QoL. In this study the children were being treated with asthma medication when they evaluated their QoL. Perhaps this fact might have influenced the results in a positive direction. Relevance to clinical practice. The findings of our study underline the importance of accurate nursing assessment including background variables of the children. Nurses also have to be aware that some of the children in the study have a low QoL and these children must not be forgotten. In addition, as caring tends to focus on the patients’ limitations, another important issue for nurses is to try to discover those aspects in a child's daily life that contribute to a high QoL in order to improve and maintain the child's wellbeing.

This study identifies what influences and characterizes family relations in families of a child with asthma. Seventeen mothers of children aged between 6 and 16 years participated in audio-taped in-depth interviews. The researchers were inspired by grounded theory in data collection and data analysis. The core category that developed was being governed by disease-engendered uncertainty. The category mothers' availability was seen in two dimensions. The first dimension, mothers' being available for the child with asthma, created two subcategories: 1. control and 2. tight bonds. The second dimension, mothers' being less available for other family members, also created two subcategories: 3. being forsaken and 4. lack of understanding. Nursing implications are discussed in relation to the findings.

This study aimed to illuminate what it is like being a child with asthma. Unstructured interviews were conducted with 14 children with asthma in Sweden. The data were analyzed using a phenomenologic hermeneutic method. The results showed that the children strived to live normal lives. Sometimes they felt that they were participants in everyday life; other times they felt like outsiders. As participants, they felt confident in their own knowledge, in other people's wish to help, and that medicine would help. As outsiders, they felt deprived, guilty, lonely, anxious, and fearful. Results were interpreted from an ecosophic as well as an existential perspective.